Face Mites and Rosacea: What the Demodex Research Shows

Mites on your face sounds alarming. They’re tiny, invisible without a microscope, and live on nearly everyone’s skin.¹ The question is whether they matter for rosacea.

Counting mites

Two 1993 studies lifted thin samples from the face with a drop of glue and counted the mites under a microscope:

Study	People	Mites, rosacea vs. no rosacea
Ireland	42 with rosacea, 42 matched without2	Average 49.8 vs 10.8 per set of six facial samples; most on the cheeks2
Belgium	49 with rosacea, 45 without3	10.8 vs 0.7 per square centimeter3

In the Belgian study, the difference was significant only in the bumps-and-pimples form of rosacea.³ In the Irish study, a month of a tetracycline antibiotic didn’t change mite counts.²

Pooling the studies

A 2017 review combined 23 studies with 1,513 people with rosacea.⁴ People with rosacea were about 9 times more likely to have a mite infestation and had more mites per patch of skin.⁴

The authors said mites may play a role, in both the redness form and the bumps form.⁴ But results varied widely between studies, and this kind of study can’t show that mites cause rosacea.⁴ One idea is that a crowd of mites triggers an immune reaction and inflammation.¹

An anti-mite cream

Ivermectin is a medicine that acts against parasites. In a trial of 962 people with moderate to severe bumps-and-pimples rosacea:⁵

• After 16 weeks, ivermectin cut inflamed bumps by 83%, against 74% for metronidazole cream.⁵
• Side effects were similar, and ivermectin was better tolerated on the skin.⁵

It works, but that doesn’t prove the mites were the cause. See rosacea prescription treatments compared.

What this means for you

1. Don’t scrub harder. Rosacea isn’t caused by poor hygiene and isn’t contagious.⁶
2. Notice the stinging. Burning or stinging when you use water or skin products is a rosacea symptom, not just “sensitive skin.”⁶
3. Redness can be harder to see on brown or black skin.⁶
4. Skip home mite-killers on your face and ask a clinician about treatment.

For the basics, see why your face is always red, and for eye symptoms, see ocular rosacea.

Try: “My cheeks flush and sting when I wash, and I get small bumps. Could this be rosacea, and would a cream like ivermectin be worth trying?”

Skin, Head to Toe covers this in Chapter 10, “Red in the Face, and Other Clues,” in a section called “The Mite That Moved.” Its section “Describe Your Own Face” turns flushing, stinging and bumps into plain descriptions, the same feature-by-feature approach dermatologists now use for rosacea. See the book.